Camp and Program Emergency Plan Form – Mason Ready | Emergency Management & Fire Safety

This form should be completed following a review of the University Camps Emergency Operations Plan (Camps EOP). The Camps EOP will provide context to some of the questions asked in the Camp and Program Emergency Plan (CPEP) form on this page. You will receive a Camps EOP with your completed CPEP form answers attached to the EOP after this form is submitted and approved. For questions, please contact Emergency Management and Fire Safety.

Step 1 of 6

General Information

Name of Person Completing This Form(Required)

First Last

Email for Correspondence Regarding this Form(Required)

Camp / Program Name(Required)

Sponsoring Organization (if applicable)

Camp Administrative Address(Required)

Street Address Address Line 2 City State ZIP Code

Camp Director(Required)

First Last

On-Campus Supervisor(Required)

First Last

Camp Begin Date(Required)

Camp End Date(Required)

Has this camp been previously hosted at George Mason University?(Required)

Yes

Years in Operation(Required)

Camp / Program Type(Required)

On-Campus Camp Location(s)

Campus Location(Required)

Building Name and Address (Fairfax)(Required)

Building Name and Address (Mason Square)(Required)

Building Name and Address (Science and Technology)(Required)

Building Name and Address (Other Locations)(Required)

All on-campus locations associated with this camp or program must be listed. Are there additional locations to report?

Yes

Additional Locations(Required)

Use the (+) symbol to add additional locations. Please list all on-campus locations associated with this camp or program. Building names, addresses, and assembly areas can be found here. If adding additional locations, a value is required under each column (building / field name and address). Incomplete entries will result in the form being returned for revision.

Building / Field Name

Address

Emergency Contacts

Some contacts have been pre-populated. Please add any additional contacts for your camp / program emergency contact list.

Role / Contact Type	Name / Office	Phone	Email
University Police (24/7)	GMU Police	703.993.2810	[email protected]
Fire / EMS	George Mason Emergency Medical Services	9-1-1	N/A
Risk, Safety, and Resilience On-Call Number	Emergency Management and Fire Safety	703.993.7233	[email protected]
Risk, Safety, and Resilience	Emergency Management and Fire Safety	703.993.8448	[email protected]

Camp Director

Camp Director Name(Required)

First Last

Camp Director Cell Phone(Required)

Camp Director Email(Required)

On-Campus Supervisor

On-Campus Supervisor Name(Required)

First Last

On-Campus Supervisor Cell Phone(Required)

On-Campus Supervisor Email(Required)

Health Supervisor

Health Supervisor Name(Required)

First Last

Health Supervisor Cell Phone(Required)

Health Supervisor Email(Required)

George Mason Camp Point of Contact

George Mason Camp Point of Contact Name

First Last

George Mason Camp Point of Contact Cell Phone

George Mason Camp Point of Contact Email

Additional Emergency Contacts

Use the (+) symbol to add additional Emergency Contacts. Please list all pertinent contacts for the camp or program. Name, cell phone number, and email are required for any additional emergency contacts.

Name / Office

Cell Phone Number

Latest Mason Alert

General Information

On-Campus Camp Location(s)

Emergency Contacts

Camp Director

On-Campus Supervisor

Health Supervisor

George Mason Camp Point of Contact

Additional Emergency Contacts

Emergency Preparedness and Resources

Emergency Response Roles and Responsibilities

Activate the Camp Emergency Alarm

Provide First Aid

Initiate Camp Evacuation / Shelter In Place

Conduct Search for Missing Camper(s)

Notify Parents in an Emergency

Assembly & Evacuation Locations

Indoor Shelter-In Place Location for Emergency Situations

Required Documentation & Acknowledgments